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4 AE > PASSMED useful things > Flashcards

PASSMED useful things Flashcards

1
Q

What causes fibrosis mainly in the upper zones of the lungs?

A

C - Coal worker’s pneumoconiosis H - Histiocytosis/ hypersensitivity pneumonitis A - Ankylosing spondylitis R - Radiation T - Tuberculosis S - Silicosis/sarcoidosis

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2
Q

What causes fibrosis mainly in the lower zones of the lungs?

A

idiopathic pulmonary fibrosis most connective tissue disorders (except ankylosing spondylitis) e.g. SLE drug-induced: amiodarone, bleomycin, methotrexate asbestosis

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3
Q

What does this CT scan show?

A

‘honeycombing’ from advanced pulmonary fibrosis

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4
Q

What are the typical clinical features of intestinal angina (chronic mesenteric ischaemia)?

A

Intestinal angina (or chronic mesenteric ischaemia) is classically characterised by a triad of severe, colicky post-prandial abdominal pain, weight loss, and an abdominal bruit - by far the most common cause is atherosclerotic disease in arteries supplying the GI tract

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5
Q

What are the differences between mesenteric ischaemia and ischaemic colitis?

A
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6
Q

What are the differences between neuroleptic malignant syndrome and serotonin syndrome?

A
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7
Q

What does this show?

A

Duodenal biopsy from a patient with coeliac disease. Complete atrophy of the villi with flat mucosa and marked crypt hyperplasia. Intraepithelial lymphocytosis. Dense mixed inflammatory infiltrate in the lamina propria.

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8
Q

What does this show?

A

Duodenal biopsy from a patient with coeliac disease. Flat mucosa with hyperplastic crypts and dense cellular infiltrate in the lamina propria. Increased number of intraepithelial lymphocytes and vacuolated superficial epithelial cell vacuolated superficial epithelial cells. Higher magnification image on the right.

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9
Q

What does a normal pulmonary capillary wedge pressure exclude?

A

Pulmonary oedema

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10
Q

What are the causes of ARDS?

A

Sepsis

Direct lung injury

Trauma

Acute pancreatitis

Long bone fracture or multiple fractures (through fat embolism)

Head injury (causes sympathetic nervous stimulation which leads to acute pulmonary hypertension)

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11
Q

How do you treat ARDS?

A

Treat the underlying cause

Antibiotics (if signs of sepsis)

Negative fluid balance i.e. Diuretics

Recruitment manoeuvres such as prone ventilation, use of positive end expiratory pressure

Mechanical ventilation strategy using low tidal volumes, as conventional tidal volumes may cause lung injury (only treatment found to improve survival rates)

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12
Q

What are the complications of SSRIs during pregnancy?

A

Use during the first trimester gives a small increased risk of congenital heart defects

Use during the third trimester can result in persistent pulmonary hypertension of the newborn

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13
Q

Which SSRI would you use post-MI?

A

sertraline is useful post myocardial infarction as there is more evidence for its safe use in this situation than other antidepressants

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14
Q

What is this?

A

Impetigo

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15
Q

What are the typical iron studies in patients with haemochromatosis?

A

transferrin saturation > 55% in men or > 50% in women

raised ferritin (e.g. > 500 ug/l) and iron

low TIBC

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16
Q

What type of pneumonia is associated with erythema multiforme?

A

Mycoplasma is associated with erythema multiforme

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17
Q

What are the differences between Legionella and Mycoplasma pneumonias?

A
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18
Q

What does this CT scan show?

A

The CT demonstrates multuple centrilobular ground glass nodules consistent with hypersensitivity pneumonitis

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19
Q

What are the features of a post-splenectomy blood film?

A

Howell- Jolly bodies (in picture, arrows pointing at them)
Pappenheimer bodies
Target cells
Irregular contracted erythrocytes

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20
Q

What do the results of an ABPI mean?

A

a ‘normal’ ABPI may be regarded as between 0.9 - 1.2. Values below 0.9 indicate arterial disease. Interestingly, values above 1.3 may also indicate arterial disease, in the form of false-negative results secondary to arterial calcification (e.g. In diabetics)

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21
Q

What are the rheumatic factor diseases?

A

Rheumatoid arthritis

Sjogren’s syndrome (around 100%)

Felty’s syndrome (around 100%)

infective endocarditis (= 50%)

SLE (= 20-30%)

systemic sclerosis (= 30%)

general population (= 5%)

rarely: TB, HBV, EBV, leprosy

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22
Q

What is this sign: Acute retrocaecal appendicitis is indicated when the right thigh is passively extended with the patient lying on their side with their knees extended.?

A

Psoas stretch sign

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23
Q

what is this sign: in acute pancreatitis there is bruising in the flanks?

A

Grey-Turner’s sign

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24
Q

What is this sign: in cholecystitis there is pain/catch of breath elicited on palpation of the right hypochondrium during inspiration?

A

Murphy’s sign

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25
Q

What are the first line investigations for acoustic neuroma?

A

audiogram and gadolinium-enhanced MRI head scan

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26
Q

What is this rash?

A

Karposi’s sarcoma

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27
Q

What should you do to metformin when you are ill?

A

Metformin increases the risk of lactic acidosis - suspend during intercurrent illness eg. diarrhoea and vomiting

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28
Q

An 11-year-old boy is seen in the Emergency Department after falling onto his left shoulder whilst playing football.

The x-ray is shown below, what has happened?:

A

There is a transverse fracture of the clavicle in the top-left of the radiograph, but more strikingly is the complete slip of the humeral epiphysis - Salter-Harris type I injury of the humerus.

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29
Q

How do you convert oral codeine and tramadol to oral morphine?

A
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30
Q

How do you convert oral morphine to oral oxycodone?

A
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31
Q

What does this barium study show?

A

Barium study is shown from a patient with worsening Crohn’s disease. Long segment of narrowed terminal ileum in a ‘string like’ configuration in keeping with a long stricture segment. Termed ‘Kantor’s string sign’.

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32
Q

What is this rash?

A

Erythema marginatum. The underlying diagnosis is rheumatic fever. This is supported by the recent sore throat, chorea (jerk, irregular movements) and polyarthralgia.

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33
Q

What is performed to assess any signs of diabetic nephropathy in an annual review?

A

All diabetic patients require annual screening for albumin:creatinine ratio (ACR) in early morning specimens. Serum urea and electrolytes may be performed in patients however they are not required as part of an annual diabetic review to look for chronic kidney disease.

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34
Q

What is the condition shown here?

A

Psoriatic arthritis, you can tell by the nail changes

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35
Q

What condition is shown here?

A

Psoriatic arthritis, you can tell by the nail changes

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36
Q

What can you see on this XR?

A

X-ray showing some of changes in seen in psoriatic arthropathy. Note that the DIPs are predominately affected, rather than the MCPs and PIPs as would be seen with rheumatoid. Extensive juxta-articular periostitis is seen in the DIPs but the changes have not yet progressed to the classic ‘pencil-in-cup’ changes that are often seen.

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37
Q

A 28-year-old who is 10 weeks pregnant is noted to be hypertensive on her booking visit. Blood show a potassium of 2.9 mmol/l. Clinical examination is unremarkable. Diagnosis?

A

At 10 weeks gestation pregnancy-induced hypertension is not a possibility. The booking visit may represent the first time this patient has had her blood pressure checked, revealing an long-standing disorder. The low potassium points to a diagnosis of primary hyperaldosteronism (of which Conn’s syndrome is a subtype)

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38
Q

A 39-year-old man presents with headaches and excessive sweating. He also reports some visual loss. Visual fields testing reveal loss of temporal vision bilaterally. Diagnosis?

A

Acromegaly

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39
Q

A 68-year-old with a history of ischaemic heart disease is seen in the hypertension clinic. Despite four antihypertensives his blood pressure is 172/94 mmHg. An abdominal ultrasound shows asymmetrical kidneys. Diagnosis?

A

Renal artery stenosis

40
Q

What can you see on this XR?

A

40-year-old male. There is typical appearance of bamboo spine with a single central radiodense line related to ossification of supraspinous and interspinous ligaments which is called dagger sign. Ankylosing is detectable in both sacroiliac joints

41
Q

What can you see on this XR?

A

Ankylosing spondylitis with well formed syndesmophytes

42
Q

What can you see on this XR?

A

Syndesmophytes and squaring of vertebral bodies. Squaring of anterior vertebral margins is due to osteitis of anterior corners. Syndesmophytes are due to ossification of outer fibers of annulus fibrosus

43
Q

Is this NG tube in the correct place?

A

The NG tube tip is satisfactorily sited in a sub-diaphragmatic position.

44
Q

Is this NG tube located in the right place?

A

The NG tube tip is located in the right lower lobe

45
Q

What are the blood results in Addisonian crisis?

A

low sodium, high potassium, low glucose

46
Q

What does this XR show?

A

Abdominal film from a patient with sigmoid volvulus. Note the signs of large bowel obstruction alongside the coffee bean sign

47
Q

What does this XR show?

A

Abdominal film from a patient with caecal volvulus. Small bowel obstruction is clearly visible on this film (note the valvulae conniventes, mucosal folds, that cross the full width of the bowel).

48
Q

What sign is shown in this picture?

A

Erythema nodosum

49
Q

After a venous thromboembolism, how long should a patient be on warfarin?

A

provoked (e.g. recent surgery): 3 months

unprovoked: 6 months

50
Q

How do you decide which treatment old people with #NOF should get?

A
51
Q

What does this CT show?

A

CT scan from a patient who presented with dyspnoea. the CT demonstrates honeycombing and traction bronchiectasis

52
Q

What does this CT show?

A

CT scan showing advanced pulmonary fibrosis including ‘honeycombing’

53
Q

What does this XR show?

A

TB. Consolidation is seen in the left upper lobe. Two calcified granulomas can also be seen on the left, one near the hilum and the second in the left lower lobe.

54
Q

What does this XR show?

A

Miliary TB

55
Q

A male infant is born by spontaneous vaginal delivery at 39 weeks gestation. He is well after the birth, established on bottle feeding and discharged home. His parents are concerned because he subsequently becomes unwell and vomits a large quantity of bile stained vomit approximately 2 days after discharge home. On examination he looks ill and his abdomen is soft and non distended. Diagnosis?

A

Intestinal malrotation with volvulus will typically compromise the vascularisation and lumenal patency of the gut. This will cause bilious vomiting and the vascular insufficiency will produce a clinical picture of illness at odds with the lack of overt abdominal signs. Delay in diagnosis and surgery will result in established necrosis, perforation and peritonitis.

56
Q

A female infant is born by cesarean section at 38 weeks gestation for foetal distress. The attending paediatricians notice that she has a single palmar crease and a slight slant to her eyes. Soon after the birth the mother tries to feed the child who has a projectile vomit about 10 minutes after feeding. On examination she has a soft, non distended abdomen. Diagnosis?

A

Duodenal atresia. Proximally sited atresia will produce high volume vomits which may or may not be bile stained. Abdominal distension is characteristically absent. Whilst under resuscitated children may be a little dehydrated they are seldom severely ill. The presence of Trisomy 21 (palmar and eye signs) increases the likelihood of duodenal atresia.

57
Q

What are the causes of billous vomiting in neonates?

A

Duodenal atresia - Few hours after birth

Malrotation with volvulus - Usually 3-7 days after birth, volvulus with compromised circulation may result in peritoneal signs and haemodynamic instability

Jejunal/ileal atresia - Usually within 24 hours of birth

Meconium ileus - Typically in first 24-48 hours of life with abdominal distension and bilious vomiting

NEC - Usually second week of life

58
Q

What would duodenal atresia show on XR?

A

AXR shows double bubble sign, contrast study may confirm

59
Q

What investigations with confirm a meconium ileus?

A

Air - fluid levels on AXR, sweat test to confirm cystic fibrosis

60
Q

What investigations confirm NEC?

A

Dilated bowel loops on AXR, pneumatosis and portal venous air

61
Q

What blood results would point towards gall bladder cancer?

A

raised ALP and bilirubin levels. Tumour markers such as Ca-19-9 and CEA may also be elevated in later-stage disease, but as this is non-specific, it cannot be relied upon for diagnosis.

62
Q

What is this rash?

A

Lichen planus

63
Q

What is this sign?

A

Spider naevi. Spider naevi can be differentiated from telangiectasia by pressing on them and watching them fill. Spider naevi fill from the centre, telangiectasia from the edge .

64
Q

What does this CXR show?

A

Chest x-ray features of legionella pnuemonia are non-specific but includes a mid-to-lower zone predominance of patchy consolidation. Pleural effusions are seen in around 30%.

65
Q

What LFTs point towards autoimmune hepatitis?

A

Autoimmune hepatitis is more likely to show predominantly raised ALT / AST on LFTs than ALP

66
Q

What sign is this?

A

Acanthosis nigricans

67
Q

What is this sign?

A

Erythema nodosum

68
Q

What is this rash associated with?

A

This is dermatitis herpatiformis, associated with coeliac disease

69
Q

what is this rash?

A

guttate psoriasis

70
Q

What are the causes of tinnitus?

A
71
Q

What does this otoscopy show?

A

The bulging nature of the tympanic membrane strongly suggests a diagnosis of otitis media. The colour of the tympanic membrane alone has a low predictive value for otitis media as it may be reddened by coughing, nose blowing, and fever.

72
Q

What are the characteristic features of the causes of facial pain?

A
73
Q

What are the characteristic features of the vertigo differential diagnoses?

A
74
Q

What does an elderly patient dizzy on extending their neck point towards?

A

Vertebrobasilar ischaemia

75
Q

What does this otoscopy show?

A

Cholesteatoma

76
Q

What can you see on the otoscope?

A

Cholesteatoma

77
Q

What is the main organism that causes haemolytic uraemic syndrome?

A

E.coli

78
Q

What does this endoscopy show?

A

Barrett’s oesophagus

79
Q

what does this barium swallow show?

A

Oesophageal cancer

80
Q

What does ‘red currant jelly’ stool indicate?

A

Intesussecption

81
Q

What are the incubation periods of organisms that induce vomiting and diarrhoea?

A

1-6 hrs: Staphylococcus aureus, Bacillus cereus*

12-48 hrs: Salmonella, Escherichia coli

48-72 hrs: Shigella, Campylobacter

> 7 days: Giardiasis, Amoebiasis

82
Q

What does a sausage shaped mass in newborns indicate?

A

Intussusception

83
Q

What is the difference in location between gastroscisis and omphalocele?

A

Gastroschisis and omphalocele present similarly, but gastroschisis refers to a defect lateral to the umbilicus whereas omphalocele refers to a defect in the umbilicus itself.

84
Q

what increases antenatal AFP?

A

Neural tube defects (meningocele, myelomeningocele and anencephaly)
Abdominal wall defects (omphalocele and gastroschisis)
Multiple pregnancy

85
Q

What decreases antenatal AFP?

A

Down’s syndrome
Trisomy 18
Maternal diabetes mellitus

86
Q

what does this barium enema show?

A

Barium enema from a patient with ulcerative colitis. The whole colon, without skips is affected by an irregular mucosa with loss of normal haustral markings.

87
Q

What does this abdo XR show?

A

Abdominal x-ray from a patient with ulcerative colitis showing lead pipe appearance of the colon (red arrows). Ankylosis of the left sacroiliac joint and partial ankylosis on the right (yellow arrow), reinforcing the link with sacroilitis.

88
Q

What do Heinz bodies indicate?

A

G6PD deficiency

89
Q

What are the differences between G6PD deficiency and heriditary spherocytosis?

A
90
Q

What are the blood results for pre-hepatic, hepatic and post-hepatic jaundice?

A
91
Q

After US, what tests are performed for hepatobilliary cancers?

A

Where pancreatic neoplasia is suspected the next test should be a pancreatic protocol CT scan.

With liver tumours and cholangiocarcinoma an MRI/ MRCP is often the preferred option.

PET scans may be used to stage a number of malignancies but do not routinely form part of first line testing.

92
Q

How can you tell the difference between cholecystitis and cholangitis and biliary colic?

A

In acute cholecystitis the patient is systemically unwell and in pain, whereas in biliary colic they won’t be systemically unwell. In acute cholangitis, they will most likely be jaundiced, which there is no mention of. Murphy’s positive sign is also a sign typical in acute cholecystitis, and is pain on inspiration during palpation of the right upper quadrant.

93
Q

What can you see in this CXR?

A

Erect chest x-ray with air visible under the diaphragm on both sides

94
Q

What can you see on this AXR?

A

Abdominal x-ray demonstrates numerous loops of small bowel outlined by gas both within the lumen and free within the peritoneal cavity. Ascites is also seen, with mottled gas densities over bilateral paracolic gutters. In a normal x-ray only the luminal surface (blue arrows) should be visible outlined by gas. The serosal surface (orange) should not be visible as it is normally in contact with other intra-abdominal content of similar density (other loops of bowel, omentum, fluid). In this case gas abuts the serosal surface rendering it visible. As this film has been obtained supine (note absence of air-fluid levels), ascites pools in the paracolic gutters, with fluid mixed in with gas bubbles.

95
Q
A

4 AE (1 decks)

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